![]() Patients with muscle disorders or who have experienced a cerebral vascular accident (CVA) are at risk for aspiration related to ineffective cough reflex, which could lead to hypoxia. ![]() Some patients may have a weakened cough that inhibits their ability to clear secretions from the mouth and throat. Mucolytics and adequate hydration decrease the thickness of pulmonary secretions so that they can be expectorated more easily. Glucocorticoids relieve inflammation and also assist in opening air passages. Medications such as bronchodilators effectively relax smooth muscles and open airways in certain disease processes such as COPD. Pharmacological management is essential for patients with respiratory disease. In hospitals where medical air and oxygen are used, ensure patient is connected to the oxygen flow port. Feel for the flow of oxygen from the exit ports on the oxygen equipment. Ensure the connecting oxygen tubing is not kinked, which could obstruct the flow of oxygen. If a portable tank is being used, check the oxygen level in the tank. If patient is already on supplemental oxygen, ensure equipment is turned on and set at the required flow rate and is connected to an oxygen supply source. If secretions are thick and tenacious, the patient may be dehydrated and require additional fluids (if medical condition does not contraindicate additional fluids). This is done three or four times, and then they are instructed to cough. This involves taking a medium breath and then making a sound like “ha” to push the air out fast with the mouth slightly open. If they have difficulty coughing, teach the huffing technique. Teach patients “controlled coughing” by having them take a deep breath in and cough deeply with the mouth slightly open. High Fowler’s positionĭeep breathing and coughing techniques help patients effectively clear their airway while maintaining their oxygen levels. Patients with COPD who are short of breath may gain relief by sitting with their back against a chair and rolling their head and shoulders forward or leaning over a bedside table while in bed. A Fowler’s or semi-Fowler’s position promotes a patient’s chest expansion with the least amount of effort. Raising the head of the bed promotes effective breathing and diaphragmatic descent, maximizes inhalation, and decreases the work of breathing. Positioning enhances airway patency in all patients. Table 5.3 Interventions to Treat and Prevent Hypoxia Interventions Hypoxia must be managed not only with supplemental oxygen but in conjunction with the interventions outlined in Table 5.3. Hypoxic patients must be assessed for the causes and underlying reasons for their hypoxia. There are no contradictions to oxygen therapy if indications for therapy are present (Kane et al., 2013). The most common reasons for initiating oxygen therapy include acute hypoxemia related to pneumonia, shock, asthma, heart failure, pulmonary embolus, myocardial infarction resulting in hypoxemia, post operative states, pneumonthorax, and abnormalities in the quality and quantity of hemoglobin. The health care provider administering oxygen is responsible for monitoring the patient response and keeping the oxygen saturation levels within the target range. Most hospitals have a protocol in place allowing health care providers to apply oxygen in emergency situations. ![]() Hypoxia is considered an emergency situation. For patients with COPD, the target SaO 2 range is 88 – 92% (Alberta Health Services, 2015 Kane, et al., 2013 Perry et al., 2014).Īlthough all medications require a prescription, oxygen therapy may be initiated without a physician’s order in emergency situations. The target range (SaO 2) for a normal adult is 92 – 98%. The essence of oxygen therapy is to provide oxygen according to target saturation rate, and to monitor the saturation rate to keep it within target range. Failure to initiate oxygen therapy can result in serious harm to the patient. Hypoxemia or hypoxia is a medical emergency and should be treated promptly. ![]()
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